Decisions about menopause depend on quality of life (QOL) considerations. The proposed project is an extension of our AHRQ-funded Women's Interactive System for Decisions on Menopause (WISDOM), an internet-based decision aid designed to help women and their clinicians make more informed decisions about menopause by linking unbiased evidence about menopausal treatments to an individual's symptoms and risks. We now seek to build on WISDOM, enhancing its functionality by incorporating utilities for health states, including the temporary health state of menopause and utilities for chronic conditions potentially affected by treatment, the goal of this proposal is to evaluate, for the first time, the effects of incorporating QOL utilities into decision support. The specific aims are: to 1) develop and optimize a web-based tool for measuring women's QOL during the menopause transition, Practical Approach to Temporary Health States (PATHS); 2) validate this tool against conventional utility measures; and 3) embed it into WISDOM (WISDOM+PATHS) and evaluate its impact on menopausal patients' decisions and outcomes and clinicians' counseling. We propose a 3-phase, 5-year study. Phase I will develop PATHS based on a prototype and conduct usability testing. Phase II will assess the tool's reliability and construct validity. Phase III will evaluate the impact of WISDOM+PATHS (versus WISDOM alone) in a randomized controlled trial (n=336) on 45 - 60 year old women's decisional conflict, satisfaction, treatment decisions and adherence, and clinician menopausal counseling. Our goals are to help menopausal women and their clinicians make better, more informed decisions about menopausal treatments by helping them to understand the implicit trade-offs between short-term QOL gains and survival losses associated with hormone therapy (HT), and the expected time course of menopausal symptoms.